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Related to pregabalin: gabapentin
Pregnancy Category: C
Pharmacologic: gamma aminobutyric acid gaba analogues
Pharmacologic: gamma aminobutyric acid gaba analogues
Neuropathic pain associated with diabetic peripheral neuropathyPostherpetic neuralgiaFibromyalgiaNeuropathic pain associated with spinal cord injuryAdjunctive therapy of partial-onset seizures in adults.
Binds to calcium channels in CNS tissues which regulate neurotransmitter release. Does not bind to opioid receptors.
Decreased neuropathic or post-herpetic pain.
Decreased partial-onset seizures.
Absorption: Well absorbed (90%) following oral administration.
Distribution: Probably crosses the blood-brain barrier.
Metabolism and Excretion: Minimally metabolized, 90% excreted unchanged in urine.
Half-life: 6 hr.
Time/action profile (↓ post–herpetic pain)
Contraindicated in: Myopathy (known/suspected); Lactation: Lactation.
Use Cautiously in: All patients (may ↑ risk of suicidal thoughts/behaviors);Renal impairment (dose alteration recommended for CCr <60 mL/min);HF;History of drug dependence/drug-seeking behavior; Obstetric: Use only if maternal benefit outweighs fetal risk; may ↑ risk of male-mediated teratogenicity; Pediatric: Safety not established; Geriatric: Consider age-related ↓ in renal function when determining dose.
Adverse Reactions/Side Effects
Central nervous system
- suicidal thoughts (life-threatening)
- dizziness (most frequent)
- drowsiness (most frequent)
- impaired attention/concentration/thinking
- edema (most frequent)
Ear, Eye, Nose, Throat
- blurred vision
- dry mouth (most frequent)
- abdominal pain
- ↑ appetite
- weight gain
- allergic reactions
Drug-Drug interactionConcurrent use with thiazolidinediones (pioglitazone,rosiglitazone ) may ↑ risk of fluid retention.↑ risk of CNS depression with other CNS depressants including opioids, alcohol, benzodiazepines, or other sedatives/hypnotics.
Diabetic Neuropathic Pain
Oral (Adults) 50 mg 3 times daily, ↑ over 7 days up to 100 mg 3 times daily
Oral (Adults) 75 mg twice daily or 50 mg 3 times daily initially, may be ↑ over 7 days to 300 mg/day in 2–3 divided doses; after 2–4 wk may be ↑ to 600 mg/day in 2–3 divided doses
Oral (Adults) 75 mg twice daily initially, may be ↑ to 150 mg twice daily within 1 wk based on efficacy and tolerability. May be ↑ to 225 twice daily
Spinal Cord Injury Neuropathic Pain
Oral (Adults) 75 mg twice daily initially, may be ↑ to 150 mg twice daily within 1 wk based on efficacy and tolerability; if insufficient pain relief after 2–3 wk, may ↑ to 300 twice daily
Partial Onset Seizures
Oral (Adults) 75 mg twice daily or 50 mg 3 times daily initially; may be gradually ↑ to 600 mg/day
Renal ImpairmentOral (Adults) CCr 30–60 mL/min—75–300 mg/day in 2–3 divided doses; CCr 15–30 mL/min—25–150 mg/day in 1–2 divided doses; CCr < 15 mL/min—25–75 mg/day as a single daily dose
Availability (generic available)
Capsules: 25 mg, 50 mg, 75 mg, 100 mg, 150 mg, 200 mg, 225 mg, 300 mg Cost: 25 mg $411.71 / 100, 50 mg $409.80 / 100, 75 mg $409.80 / 100, 100 mg $409.80 / 100, 150 mg $409.80 / 100, 200 mg $411.71 / 100, 225 mg $411.71 / 100
Oral solution: 20 mg/mL Cost: $553.82 / 473 mL
- Monitor closely for notable changes in behavior that could indicate the emergence or worsening of suicidal thoughts or behavior or depression.
- Diabetic Peripheral Neuropathy, Postherpetic Neuralgia, Fibromyalgia, and Spinal Cord Injury Pain: Assess location, characteristics, and intensity of pain periodically during therapy.
- Seizures: Assess location, duration, and characteristics of seizure activity.
- Lab Test Considerations: May cause ↑ creatine kinase levels.
- May cause↓ platelet count.
Potential Nursing DiagnosesRisk for injury (Adverse Reactions)
- Do not confuse Lyrica (pregabalin) with Lopressor (metoprolol).
- Pregabalin should be discontinued gradually over at least 1 wk. Abrupt discontinuation may cause insomnia, nausea, headache, anxiety, sweating, and diarrhea when used for pain and may cause increase in seizure frequency when treating seizures.
- Oral: May be administered without regard to meals. Oral solution may be stored at room temperature.
- Instruct patient to take medication as directed. If a dose is missed take as soon as remembered unless almost time for next dose; do not double doses. Do not discontinue abruptly; may cause insomnia, nausea, headache, or diarrhea or increase in frequency of seizures. Advise patient to read the Patient Information Leaflet prior to taking pregabalin.
- May cause dizziness, drowsiness, and blurred vision. Caution patient to avoid driving or activities requiring alertness until response to medication is known. Advise patient to notify health care professional if changes in vision occur. Patients with seizures should not resume driving until health care professional gives clearance based on control of seizure disorder.
- Instruct patient to promptly report unexplained muscle pain, tenderness, or weakness, especially if accompanied by malaise or fever. Discontinue therapy if myopathy is diagnosed or suspected or if markedly elevated creatine kinase levels occur.
- Advise patient and family to notify health care professional if thoughts about suicide or dying, attempts to commit suicide; new or worse depression; new or worse anxiety; feeling very agitated or restless; panic attacks; trouble sleeping; new or worse irritability; acting aggressive; being angry or violent; acting on dangerous impulses; an extreme increase in activity and talking, other unusual changes in behavior or mood occur.
- Inform patient that pregabalin may cause edema and weight gain.
- Caution patient to avoid alcohol or other CNS depressants with pregabalin.
- Instruct patient to notify health care professional of medication regimen before treatment or surgery.
- Advise female patient to notify health care professional if pregnancy is planned or suspected or if breast feeding. Inform male patients who plan to father a child of the potential risk of male-mediated teratogenicity. Encourage patients who become pregnant to enroll in the NAAED Pregnancy Registry by calling 1–800–233–2334.
- Advise patient to carry identification describing disease process and medication regimen at all times.
- Decrease in intensity of chronic pain.
- Decrease in the frequency or cessation of seizures.